Citation Nr: 21032489 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-48 809 DATE: May 27, 2021 REMAND Entitlement to service connection for hypertension, to include as due to herbicide agent exposure, is remanded. REASONS AND FOR REMAND The Veteran served on active duty from March 1966 to February 1969, to include service in the Republic of Vietnam. This matter is before the Board of Veterans' Appeals (Board) on appeal of a December 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). It was previously before the Board in September 2020, where it was remanded for additional development. In September 2017, the Veteran requested a hearing before a Veterans Law Judge at his local VA office. However, in an April 2019 correspondence, the Veteran withdrew his hearing request. While the Board regrets further delay, the claim must once again be remanded. The Veteran has a diagnosis of hypertension that he asserts is related to his military service, to include exposure to herbicide agents during his service in the Republic of Vietnam. VA laws and regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. §1116(a)(3); 38 C.F.R. §3.307(a)(6)(iii). As the Board noted in its previous remand, the list of diseases associated with exposure to certain herbicide agents does not include hypertension. 38 C.F.R. §3.309(e). As such, the Veteran cannot avail himself of the presumptive provisions to establish entitlement to service connection for the claimed condition. Nevertheless, as VA has a duty to assist the Veteran in the development of the claim by seeking a medical opinion on the question of the nature and etiology of the claimed disability, the matter was remanded to afford him an VA examination to determine the nature and etiology of his hypertension. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4)(i). The examination was provided in April 2021, where the examiner opined in the negative that it was less likely than not that the Veteran's hypertension is related to herbicide agent exposure. The examiner explained that while there is some medical literature associating higher rates of hypertension in veterans exposed to herbicide agents versus those unexposed, a causal link has not been established. The Board notes, however, that the examiner did state, somewhat speculatively, that essential hypertension is an extremely common condition, "especially in individuals with a known history of severe cardiovascular disease as this veteran has." Indeed, the Veteran is currently service connected for ischemic heart disease (IHD). As such, an addendum opinion as to whether the Veteran's hypertension is related to his IHD on a secondary basis is warranted. See 38 C.F.R. § 3.310. The matter is REMANDED for the following action: Send the claims file to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hypertension was (a) caused, or (b) aggravated (i.e., worsened beyond its natural progression) by his service-connected ischemic heart disease. The need for an additional examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Scarduzio, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.